Abstract
Background: A core tenet of implementation science is to plan for implementation with key invested partners. However, when clinical partners are involved, the limited availability of clinical staff and leaders and their patients to be included early on in the design, planning and implementation of screening tools can make this process challenging. This paper presents a participatory engagement methodology of co-creation used to design and align screening tools to local clinical contexts that is informed by complex systems thinking. We describe this methodology and illustrate ways to use it with two case examples – one related to implementing guideline-concordant cancer screening in primary care with attention to behavioral cancer risks as well as social determinants of health for older adults with a recent cancer diagnosis, to inform cancer treatment planning tailored to the presence or absence of frailty.
Methods: We conducted workshops with clinic partners with a specific cancer prevention/control goal (e.g., prevention, treatment) as well as their patient partners. Clinical and patient partners co-created the knowledge and direction of the design and implementation of cancer screening tools. Concepts from complex systems thinking (i.e., functions as core goals and forms as actions) informed the co-creation process as a way to increase the relevance and implementability of the screening tools. Sessions focused on convening partners (who) to refine the core functions of the tools (why), and align concrete forms (how) such as clinical workflows, adaptations, and implementation strategies. Workshop facilitators used prioritization and ranking exercises to inform decision-making. This methodological approach allowed us to tailor the tools in two contexts – oncology clinics and primary care settings.
Results: Clinic partners with diverse roles across clinical settings (n=15) in the University of Colorado Cancer Center (oncologists, nurses, clinic leadership, and Electronic Medical Records informaticists) participated in ## co-creation workshops of 45-90 minutes, in English and Spanish. Older patients (n=5-10) ages >65 years participated in the workshops that included user testing of the screening tools. We obtained valuable expertise from partners on informing the intervention’s core functions (e.g., function priority for patients such as service linkage after screenings), acceptability, potential challenges to its implementation, suggestions for workflow, and strategies that include the presentation and delivery of the screening tool (e.g. FUNCTION: Integrated, actionable report to care team and patient/caregiver; FORMS: online or paper-based, EMR integration). The specific Forms were tailored to partner clinic characteristics (e.g., preference for completion prior to a visit or in the waiting room). This process led to the development and refinement of processes and workflows for two patient-centered screening tools – The Integrated Aging Assessment for Action in Cancer Patients” (IA3-CP) for geriatric risk assessment before treatment planning, and the My Own Health Report (MOHR).
Impact: Our co-creation methodology was informed by patients and implementers to design and refine the screening tool and co-develop workflows for implementing guideline-concordant approaches to cancer screening and treatment plans. This work addressed health equity for older adults, a patient population often excluded from intervention design and planning, and individuals with unmet social needs.